Business Name:    
Premises Address:
Zip Code:
Contact Name:
Phone #:    Ext #:
Fax:    Years in Business:
Email Address: (Required) 
Federal Employer's ID #:
Description of Operations or SIC code:

Florida Vehicle Information:
(if more than 3 commercial vehicles please provide best time to contact)

Vehicle     Year              Make              Model             Body Type

Additional Vehicle Information:

                Miles          Cost                                     Where              Lienholder      Lienholder
Vehicle   Driven         New            VIN#               Garaged              Yes/No             Name

Florida Commercial Auto Insurance Coverage Information:

                      Liability                 Property                   Uninsured
Vehicle  Combined Limits          Damage               Combined Limits         Medical
     2             SAME                       SAME                       SAME                   SAME
     3             SAME                       SAME                       SAME                   SAME

                   Collision         Comprehensive
Vehicle    Deductible           Deductible

Florida Driver Information:

                                  Drivers                          Date of                                              Drivers
Driver                       Name                               Birth                  Gender                 License #

Is each employee's driving record accident & violation free during the past 5 years?
     1         If No, how many accidents?    How many violations? 
     2         If No, how many accidents?    How many violations? 
     3         If No, how many accidents?    How many violations? 

Was any employee's driver's license suspended during the past 5 years?

Recent Insurance Information:

Current Insurance Company: 
Expiration Date: (mm/dd/yyyy)
Any losses past 3 years:
Description of losses, including amount paid on each accident:

Additional Information or Comments

Click on the "Submit Quote Information" button below to send your
Florida Commercial Auto Insurance quote request.**

**Information received from this Florida Commercial Auto Insurance quote request form
sent to FCI Insurance Agency will be for our use only and will not be sold,
given to, or distributed to any other parties. A quote will be based on the commercial auto
insurance information provided and does not guarantee acceptance of the risk by us.
The precise coverage afforded is subject to meeting underwriting guidelines, and the terms,
conditions and exclusions of the policy as issued. By submitting this request you
acknowledge that this is neither an offer to insure nor a guarantee of insurance.
Completion of this form does not entitle your business to a Florida Commercial Auto
Insurance policy. We are licensed in Florida and will not provide commercial auto
insurance quotes for other states.

We are a Davie, FL insurance agency offering Florida commercial auto
insurance quotes to small, mid-sized and large businesses located in the
following cities and counties: Coral Springs, Fort Lauderdale, Parkland,
Coconut Creek, Margate, North Lauderdale, Lighthouse Point, Hillsboro
Beach, Deerfield Beach, Boca Raton, The Hamptons, Highland Beach,
Weston, Plantation, Playland Isles, Melrose Park, Lauderhill, Sunrise,
Tamarac, Wilton Manors, Oakland Park, Lauderdale Lakes, Sea Ranch
Lakes, Villages of Oriole, Pompano Beach, Lauderdale-by-the-Sea, Boca
West, Delray Beach, Boca Pointe, Boynton Beach, Lantana, Rainbow
Lakes, Atlantis, Lake Worth, Miami, South Palm Beach, Palm Springs,
Greenacres, Wellington, Haverhill, Palm Beach, Golden Lakes, Riviera
Beach, Glen Ridge, West Palm Beach, Lake Park, Royal Palm Beach,
Jupiter, Juno Beach, North Palm Beach, Loxahatchee, Belle Glade, Palm
Beach Shores, South Miami, Cutler Ridge, Princeton, Perrine, Naranja,
Homestead, Florida City, Leisure City, Richmond Heights, Pinecrest,
Howard, Coral Way Village, Westchester, Westwood Lakes, Brownsville,
Sweetwater, Key Biscayne, North Bay Village, Miami Beach, Miami
Springs, Virginia Gardens, Hialeah, El Portal, Miami Shores, Medley,
Indian Creek, Surfside, Bal Harbour, North Miami, Biscayne Park,
Pinewood Park, Opa Locka, Bunche Park, Hialeah Gardens, Palm Springs
North, Carol City, Norland, Ojus, Miami Lakes, Biscayne Gardens,
Hallandale, Sunny Isles Beach, Golden Beach, Aventura, Uleta, Miramar,
Pembroke Pines, North Miami Beach, Hallandale Beach, Ives Estates,
Pembroke Park, Coral Gables, Kendall, Dania Beach, Cooper City, West
Miami, Hollywood, Broward County, Palm Beach County, and Miami-Dade
County, FL. We can also offer Florida commercial auto insurance quotes to
small businesses throughout the Sunshine state, including in Orlando,
Tampa, St. Petersburg, Sarasota, Tallahassee, Gainesville, Ocala, and
Jacksonville, FL.

FCI Insurance
Agency of Davie, FL offers
affordable and
comprehensive business
insurance coverage services
throughout Florida.
Contact us about Florida
Business Liability, Group
Health, and Commercial Auto
Insurance at (954) 434-6515.
In addition to Florida
Commercial Auto Insurance
quotes, we also offer
affordable Business
Liability Insurance policy
premium quotes.
Florida Commercial
Auto Insurance Quote
We provide comprehensive
Florida Commercial Auto
Insurance coverage services
throughout the Sunshine State!
Florida Business Information:
Your Florida Commercial
Auto Insurance Source
FCI Insurance Agency
& Auto Tag Service
8230 Griffin Road
Davie, Florida 33328
Broward County FL
(954) 434-6515
Fax: (954) 434-6524

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